Repair of calvarial defects with customized tissue-engineered bone grafts - I. Evaluation of osteogenesis in a three-dimensional culture system

Bone generation by autogenous cell transplantation in combination with a biodegradable scaffold is one of the most promising techniques being developed in craniofacial surgery. The objective of this combined in vitro and in vivo study was to evaluate the morphology and osteogenic differentiation of bone marrow derived mesenchymal progenitor cells and calvarial osteoblasts in a two-dimensional (2-D) and three-dimensional (3-D) culture environment (Part I of this study) and their potential in combination with a biodegradable scaffold to reconstruct critical-size calvarial defects in an autologous animal model [Part II of this study; see Schantz, J.T., et al. Tissue Eng. 2003;9(Suppl. 1):S-127-S-139; this issue]. New Zealand White rabbits were used to isolate osteoblasts from calvarial bone chips and bone marrow stromal cells from iliac crest bone marrow aspirates. Multilineage differentiation potential was evaluated in a 2-D culture setting. After amplification, the cells were seeded within a fibrin matrix into a 3-D polycaprolactone (PCL) scaffold system. The constructs were cultured for up to 3 weeks in vitro and assayed for cell attachment and proliferation using phase-contrast light, confocal laser, and scanning electron microscopy and the MTS cell metabolic assay. Osteogenic differentiation was analyzed by determining the expression of alkaline phosphatase (ALP) and osteocalcin. The bone marrow-derived progenitor cells demonstrated the potential to be induced to the osteogenic, adipogenic, and chondrogenic pathways. In a 3-D environment, cell-seeded PCL scaffolds evaluated by confocal laser microscopy revealed continuous cell proliferation and homogeneous cell distribution within the PCL scaffolds. On osteogenic induction mesenchymal progenitor cells (12 U/L) produce significantly higher (p < 0.05) ALP activity than do osteoblasts (2 U/L); however, no significant differences were found in osteocalcin expression. In conclusion, this study showed that the combination of a mechanically stable synthetic framework (PCL scaffolds) and a biomimetic hydrogel (fibrin glue) provides a potential matrix for bone tissue-engineering applications. Comparison of osteogenic differentiation between the two mesenchymal cell sources revealed a similar pattern.

Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE) : a randomised trial

Background: The two-stage Total Laparoscopic Hysterectomy (TLH) versus Total Abdominal Hysterectomy (TAH) for stage I endometrial cancer (LACE) randomised controlled trial was initiated in 2005. The primary objective of stage 1 was to assess whether TLH results in equivalent or improved QoL up to 6 months after surgery compared to TAH. The primary objective of stage 2 was to test the hypothesis that disease-free survival at 4.5 years is equivalent for TLH and TAH. Results addressing the primary objective of stage 1 of the LACE trial are presented here. Methods: The first 361 LACE participants (TAH n= 142, TLH n=190) were enrolled in the QoL substudy at 19 centres across Australia, New Zealand and Hong Kong, and 332 completed the QoL analysis. Randomisation was performed centrally and independently from other study procedures via a computer generated, web-based system (providing concealment of the next assigned treatment) using stratified permuted blocks of 3 and 6, and assigned patients with histologically confirmed stage 1 endometrioid endometrial adenocarcinoma and ECOG performance status <2 to TLH or TAH stratified by histological grade and study centre. No blinding of patients or study personnel was attempted. QoL was measured at baseline, 1 and 4 weeks (early), and 3 and 6 months (late) after surgery using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. The primary endpoint was the difference between the groups in QoL change from baseline at early and late time points (a 5% difference was considered clinically significant). Analysis was performed according to the intention-to-treat principle using generalized estimating equations on differences from baseline for the early and late QoL recovery. The LACE trial is registered with clinicaltrials.gov (NCT00096408) and the Australian New Zealand Clinical Trials Registry (CTRN12606000261516). Patients for both stages of the trial have now been recruited and are being followed up for disease-specific outcomes. Findings: The proportion of missing values at the 5%, 10% 15% and 20% differences in the FACT-G scale was 6% (12/190) in the TLH and 14% (20/142) in the TAH group. There were 8/332 conversions (2.4%, 7 of which were from TLH to TAH). In the early phase of recovery, patients undergoing TLH reported significantly greater improvement of QoL from baseline compared to TAH in all subscales except the emotional and social well-being subscales. Improvements in QoL up to 6 months post-surgery continued to favour TLH except for the emotional and social well-being of the FACT and the visual analogue scale of the EuroQoL five dimensions (EuroQoL-VAS). Length of operating time was significantly longer in the TLH group (138±43 mins), than in the TAH group at (109±34 mins; p=0.001). While the proportion of intraoperative adverse events was similar between the treatment groups (TAH 8/142, 5.6%; TLH 14/190, 7.4%; p=0.55), postoperatively, twice as many patients in the TAH group experienced adverse events of CTC grade 3+ than in the TLH group (33/142, 23.2% and 22/190, 11.6%, respectively; p=0.004). Postoperative serious adverse events occurred more frequently in patients who had a TAH (27/142, 19.0%) than a TLH (15/190, 7.9%) (p=0.002). Interpretation: QoL improvements from baseline during early and later phases of recovery, and the adverse event profile significantly favour TLH compared to TAH for patients treated for Stage I endometrial cancer.

An alginate-based hybrid system for growth factor delivery in the functional repair of large bone defects

The treatment of challenging fractures and large osseous defects presents a formidable problem for orthopaedic surgeons. Tissue engineering/regenerative medicine approaches seek to solve this problem by delivering osteogenic signals within scaffolding biomaterials. In this study, we introduce a hybrid growth factor delivery system that consists of an electrospun nanofiber mesh tube for guiding bone regeneration combined with peptide-modified alginate hydrogel injected inside the tube for sustained growth factor release. We tested the ability of this system to deliver recombinant bone morphogenetic protein-2 (rhBMP-2) for the repair of critically-sized segmental bone defects in a rat model. Longitudinal [mu]-CT analysis and torsional testing provided quantitative assessment of bone regeneration. Our results indicate that the hybrid delivery system resulted in consistent bony bridging of the challenging bone defects. However, in the absence of rhBMP-2, the use of nanofiber mesh tube and alginate did not result in substantial bone formation. Perforations in the nanofiber mesh accelerated the rhBMP-2 mediated bone repair, and resulted in functional restoration of the regenerated bone. [mu]-CT based angiography indicated that perforations did not significantly affect the revascularization of defects, suggesting that some other interaction with the tissue surrounding the defect such as improved infiltration of osteoprogenitor cells contributed to the observed differences in repair. Overall, our results indicate that the hybrid alginate/nanofiber mesh system is a promising growth factor delivery strategy for the repair of challenging bone injuries.

The influence of fibrin based hydrogels on the chondrogenic differentiation of human bone marrow stromal cells

Mesenchymal Stem Cells (MSC) are frequently incorporated into osteochondral implants and cell seeding is often facilitated with hydrogels which exert a profound influence on the chondrogenic differentiation of MSC. An attempt was made to elucidate this effect by comparing the chondrogenic differentiation of Bone Marrow Stromal Cells (BMSC) in fibrin and fibrin alginate composites. A biphasic osteochondral model which simulated the native in vivo environment was employed in the study. In the first stage of the experiment, BMSC was encapsulated in fibrin, Fibrin Alginate 0.3% (FA0.3) and 0.6% (FA0.6). Chondrogenic differentiation within these cell-hydrogel pellets was compared against that of standard cell pellets under inductive conditions and the matrices which supported chondrogenesis were used in the cartilage phase of biphasic constructs. Neo-cartilage growth was monitored in these cocultures. It was observed that hydrogel encapsulation influenced mesenchymal condensation which preceded chondrogenic differentiation. Early cell agglomeration was observed in fibrin as compared to fibrin alginate composites. These fibrin encapsulated cells differentiated into chondrocytes which secreted aggrecan and collagen II. When the alginate content rose from 0.3 to 0.6%, chondrogenic differentiation declined with a reduction in the expression of collagen II and aggrecan. Fibrin and FA0.3 were tested in the cartilage phase of the biphasic osteochondral constructs and the former supported superior cartilage growth with higher cellularity, total Glycosaminoglycan (GAG) and collagen II levels. The FA0.3 cartilage phase was found to be fragmented and partially calcified. The use of fibrin for cartilage repair was advocated as it facilitated BMSC chondrogenesis and cartilaginous growth in an osteochondral environment.

Repair and regeneration of osteochondral defects in the articular joints

People suffering from pain due to osteoarthritic or rheumatoidal changes in the joints are still waiting for a better treatment. Although some studies have achieved success in repairing small cartilage defects, there is no widely accepted method for complete repair of osteochondral defects. Also joint replacements have not yet succeeded in replacing of natural cartilage without complications. Therefore, there is room for a new medical approach, which outperforms currently used methods. The aim of this study is to show potential of using a tissue engineering approach for regeneration of osteochondral defects. The critical review of currently used methods for treatment of osteochondral defects is also provided. In this study, two kinds of hybrid scaffolds developed in Hutmacher's group have been analysed. The first biphasic scaffold consists of fibrin and PCL. The fibrin serves as a cartilage phase while the porous PCL scaffold acts as the subchondral phase. The second system comprises of PCL and PCL-TCP. The scaffolds were fabricated via fused deposition modeling which is a rapid prototyping system. Bone marrow-derived mesenchymal cells were isolated from New Zealand White rabbits, cultured in vitro and seeded into the scaffolds. Bone regenerations of the subchondral phases were quantified via micro CT analysis and the results demonstrated the potential of the porous PCL and PCL-TCP scaffolds in promoting bone healing. Fibrin was found to be lacking in this aspect as it degrades rapidly. On the other hand, the porous PCL scaffold degrades slowly hence it provides an effective mechanical support. This study shows that in the field of cartilage repair or replacement, tissue engineering may have big impact in the future. In vivo bone and cartilage engineering via combining a novel composite, biphasic scaffold technology with a MSC has been shown a high potential in the knee defect regeneration in the animal models. However, the clinical application of tissue engineering requires the future research work due to several problems, such as scaffold design, cellular delivery and implantation strategies.

Evaluation of a hybrid scaffold/cell construct in repair of high-load-bearing osteochondral defects in rabbits

The objective of this study was to evaluate the feasibility and potential of a hybrid scaffold system in large- and high-load-bearing osteochondral defects repair. The implants were made of medical-grade PCL (mPCL) for the bone compartment whereas fibrin glue was used for the cartilage part. Both matrices were seeded with allogenic bone marrow-derived mesenchymal cells (BMSC) and implanted in the defect (4 mm diameter×5 mm depth) on medial femoral condyle of adult New Zealand White rabbits. Empty scaffolds were used at the control side. Cell survival was tracked via fluorescent labeling. The regeneration process was evaluated by several techniques at 3 and 6 months post-implantation. Mature trabecular bone regularly formed in the mPCL scaffold at both 3 and 6 months post-operation. Micro-Computed Tomography showed progression of mineralization from the host–tissue interface towards the inner region of the grafts. At 3 months time point, the specimens showed good cartilage repair. In contrast, the majority of 6 months specimens revealed poor remodeling and fissured integration with host cartilage while other samples could maintain good cartilage appearance. In vivo viability of the transplanted cells was demonstrated for the duration of 5 weeks. The results demonstrated that mPCL scaffold is a potential matrix for osteochondral bone regeneration and that fibrin glue does not inherit the physical properties to allow for cartilage regeneration in a large and high-load-bearing defect site. Keywords: Osteochondral tissue engineering; Scaffold; Bone marrow-derived precursor cells; Fibrin glue

Transition of chromium oxyhydroxide nanomaterials to chromium oxide : a hot stage Raman spectroscopic study

The transition of disc-like chromium hydroxide nanomaterials to chromium oxide nanomaterials has been studied by hot stage Raman spectroscopy. The structure and morphology of α-CrO(OH) synthesised using hydrothermal treatment was confirmed by X-ray diffraction and transmission electron microscopy. The Raman spectrum of α-CrO(OH) is characterised by two intense bands at 823 and 630 cm-1 attributed to ν1 CrIII-O symmetric stretching mode, bands at 1179 cm-1 attributed to CrIII-OH δ deformation modes. No bands are observed above 3000 cm-1. The absence of characteristic OH vibrational bands may be due to short hydrogen bonds in the α-CrO(OH) structure. Upon thermal treatment of α-CrO(OH), new Raman bands are observed at 599, 542, 513, 396, 344 and 304 cm-1, which are attributed to Cr2O3. This hot-stage Raman study shows that the transition of α-CrO(OH) to Cr2O3 occurs before 350 °C.

Transition of synthetic chromium oxide gel to crystalline chromium oxide : a hot stage Raman spectroscopic study

Chromium oxide gel material was synthesised and appeared to be X-ray amorphous. The changes in the structure of the synthetic chromium oxide gel were investigated using hot-stage Raman spectroscopy based upon the results of thermogravimetric analysis. The thermally decomposed product of the synthetic chromium oxide gel in nitrogen atmosphere was confirmed to be crystalline Cr2O3 as determined by the hot-stage Raman spectra. Two bands were observed at 849 and 735 cm-1 in the Raman spectrum at 25 °C, which were attributed to the symmetric stretching modes of O-CrIII-OH and O-CrIII-O. With temperature increase, the intensity of the band at 849 cm-1 decreased, while the band at 735 cm-1 increased. These changes in intensity are attributed to the loss of OH groups and formation of O-CrIII-O units in the structure. A strongly hydrogen bonded water H-O-H bending band was found at 1704 cm-1 in the Raman spectrum of the chromium oxide gel, however this band shifted to around 1590 cm-1 due to destruction of the hydrogen bonds upon thermal treatment. Six new Raman bands were observed at 578, 540, 513, 390, 342 and 303 cm-1 attributed to the thermal decomposed product Cr2O3. The use of the hot-stage Raman microscope enabled low-temperature phase changes brought about through dehydration and dehydroxylation to be studied.

Old Brisbane Botanic Gardens: Conservation Plan Review 2005, Report of Stage 1 Heritage Significance and Conservation Policies

Report for City Design, for Environment and Parks, within the Brisbane City Council. Context of this Project A Conservation Study for the Old Brisbane Botanic Gardens, formerly called the Brisbane City Botanic Gardens, was finalised in 1995 and prepared by Jeannie Sim for the Landscape Section of Brisbane City Council, the same author of the present report. This unpublished report was the first conservation plan prepared for the place and it was recommended that it be reviewed in five years time. That time has arrived finally with the preparation of the 2005 Review. The present project was commissioned by City Design on behalf of Environment and Parks Section of Brisbane City Council. The author has purposely chosen to call the study site the 'Old Brisbane Botanic Gardens' (OBBG) to differentiate it from the Brisbane Botanic Gardens, Mt. Coot-tha (BBG-MC), and to maintain the claim for this original garden to remain as a botanic garden for Brisbane. This name immediately brings to mind an association with history, as in the precedent set by the naming of the nearby 'Old Government House' at Gardens Point.

A closer look at business planning : early stage outcome effects of how it is prepared and used

The widespread use of business planning in combination with the mixed theoretical and empirical support for its effect suggest research is needed that takes a deeper into the quality of plans and how they are used. In this study we longitudinally examine use vs. non-use; degree of formalizations; revision of plans, and moderation of planning effects by product novelty,among nascent firms. We relate these to attainment of profitability after 12 months. We find that business planning is negatively related to profitability, but that revising plans is positively related to profitability. Both these effects are stronger under conditions of high product novelty.

Using decision trees in economizer repair decision making

The economiser is a critical component for efficient operation of coal-fired power stations. It consists of a large system of water-filled tubes which extract heat from the exhaust gases. When it fails, usually due to erosion causing a leak, the entire power station must be shut down to effect repairs. Not only are such repairs highly expensive, but the overall repair costs are significantly affected by fluctuations in electricity market prices, due to revenue lost during the outage. As a result, decisions about when to repair an economiser can alter the repair costs by millions of dollars. Therefore, economiser repair decisions are critical and must be optimised. However, making optimal repair decisions is difficult because economiser leaks are a type of interactive failure. If left unfixed, a leak in a tube can cause additional leaks in adjacent tubes which will need more time to repair. In addition, when choosing repair times, one also needs to consider a number of other uncertain inputs such as future electricity market prices and demands. Although many different decision models and methodologies have been developed, an effective decision-making method specifically for economiser repairs has yet to be defined. In this paper, we describe a Decision Tree based method to meet this need. An industrial case study is presented to demonstrate the application of our method.

The play's the thing? : Hamlet, Slings & Arrows, and the authority of theatrical consumption

This paper reads season 1 of the critically-acclaimed Canadian television series “Slings & Arrows” (2003). This six-episode series is set in a fictionalised version of the Stratford Festival, and tells the story of a plagued production of Shakespeare’s Hamlet. It follows the play’s rehearsal after the death of the festival’s artistic director; Geoffrey Tennant (himself a plagued Hamlet) takes over the role of director, and must face his past in order to produce a Hamlet that will save the festival, redeem his reputation, and repair his interpersonal relationships. Drawing on popular and theatrical understandings of Shakespeare’s play, the series negotiates tropes of metatheatre, filiality, cultural production and consumption, in order to demonstrate the ongoing relevance and legitimacy of “Shakespeare” in the twenty-first century. The “Slings & Arrows” narrative revolves around the doubled-plot of Hamlet and the experiences of the company mounting Hamlet. In quite obvious ways, the show thus thematises ways in which Shakespeare can be used to read one’s own life and world. In the broader sense, however, the show also offers theatre/performance as a catalyst for affect. In doing so, the show functions as a relatively straight adaptation of Hamlet, and a metatheatrical/metafictional commentary on the functions of Hamlet within contemporary culture. In Shakespeare’s play, the production of “The Mouse-Trap” proves, both to Hamlet and the audience, the legitimacy of the ghost’s claims. Similarly, in “Slings & Arrows”, the successful performance of Hamlet legitimises Geoffrey’s position as artistic director of the festival, and affirms for the viewer the value of Shakespearean production in contemporary culture. In each text, theatre/performance enables and legitimises a son carrying out a dead father’s wishes in order to restore or reproduce socio-cultural order. The metatheatrics of these gestures engage the reader/viewer in a self-reflexive process whereby the ‘value’ of theatre is thematised and performed, and the consumer is positioned as the arbiter and agent of that value: complicit in its production even as they are the site of its consumption.

A Two-stage information filtering based on rough decision rule and pattern mining

Information Overload and Mismatch are two fundamental problems affecting the effectiveness of information filtering systems. Even though both term-based and patternbased approaches have been proposed to address the problems of overload and mismatch, neither of these approaches alone can provide a satisfactory solution to address these problems. This paper presents a novel two-stage information filtering model which combines the merits of term-based and pattern-based approaches to effectively filter sheer volume of information. In particular, the first filtering stage is supported by a novel rough analysis model which efficiently removes a large number of irrelevant documents, thereby addressing the overload problem. The second filtering stage is empowered by a semantically rich pattern taxonomy mining model which effectively fetches incoming documents according to the specific information needs of a user, thereby addressing the mismatch problem. The experimental results based on the RCV1 corpus show that the proposed twostage filtering model significantly outperforms the both termbased and pattern-based information filtering models.